Abstract: Appealing to Guilt to Promote Organ Donation Registration: A Preliminary Investigation of Reparative and Hedonic Efficacy Appeals

◆ Christofer Skurka, Penn State University
◆ Tobias Reynolds-Tylus, James Madison University

In the United States, there are currently over 113,000 people awaiting a life-saving organ transplant (United Network for Organ Sharing, 2019), yet only 54% of U.S. adults are registered donors (Donate Life America, 2017). To motivate non-donors to register, health communicators have often turned to guilt appeals, given that guilt is associated with prosocial tendencies (Baumeister et al., 1994). Guilt appeals typically follow a two-component structure: a first component designed to evoke guilt and a second component to promote efficacy (O'Keefe, 2002). Specifically, guilt appeals should benefit from cues about how one can atone for one’s wrongdoing (Dillard & Nabi, 2006)—a term we introduce called “reparative efficacy.” Alternatively, guilt’s prosocial tendencies may be driven not by a desire to repair the wrongdoing but a desire to alleviate one’s negative emotional state (Boster et al., 1999)—a prediction grounded in the negative state relief model (Cialdini et al., 1973). We refer this type of efficacy as “hedonic efficacy.” Communication researchers have yet to compare whether these two types of efficacy appeals might enhance the persuasiveness of a guilt appeal, so we explored non-organ donors’ reactions to narrative guilt appeals when combined with various efficacy cues.
In a between-subjects experiment, undergraduate participants (N = 244 non-donors) read a fictional narrative about a woman in need of a heart transplant. The experiment followed a 2 (helplessness narrative: high vs. low) × 4 (efficacy appeal: self-efficacy only vs. self-efficacy/reparative efficacy vs. self-efficacy/hedonic efficacy vs. no efficacy) + 1 (offset control) design. To evoke varying levels of guilt, we manipulated helplessness by portraying the protagonist as a single mom struggling to get by (high helplessness) or as a mom fortunate to have her husband’s help (low helplessness). The narrative was followed by (1) a self-efficacy appeal (“It is easy to register”), (2) a self-efficacy appeal along with reparative efficacy language (e.g., “Registering…[can] help those on the waiting list”), (3) a self-efficacy appeal along with hedonic efficacy language (e.g., “Registering…[can] make yourself feel better”), or (4) no efficacy cues (“Sign up today”). Participants in the offset control group did not read any messages.
Analyses indicated that the high helplessness narrative produced greater empathy and identification with the characters (but not more guilt) than the low version. Relative to the no-efficacy condition, only the self/hedonic appeal increased intentions to register as an organ donor. This main effect was qualified by a two-way interaction; the self/hedonic appeal promoted intentions (vs. no-efficacy) but only among participants reading the high helplessness narrative.
These preliminary findings point to the potential for hedonic, “feel-good” messaging to encourage non-donors to register. Though our narrative manipulation did not influence feelings of guilt, interestingly, our results suggest that the persuasiveness of an empathy-arousing narrative may be greatest when accompanied not by reparative efficacy cues (i.e., how taking action will help the person in need) but by hedonic efficacy cues (i.e., how taking action will improve one’s mood). Implications for persuasive message design and empathic decision-makers’ judgments are discussed.